Endoscopic prediction of advanced histology in diminutive and small colorectal polyps

Iwai, Tomohiro; Imai, Kenichiro; Ito, Sayo; Yamaguchi, Yoshihiro; Kawata, Noboru; Tanaka, Masaki; Kakushima, Naomi; Takizawa, Kohei; Ishiwatari, Hirotoshi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

doi:10.1111/jgh.14409

Cited by 19 publications

(14 citation statements)

References 38 publications

(79 reference statements)

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“…The benefit of ECV was exclusively in finding more small adenomas; the rate of advanced histology is generally low, but ranges from 0.6% to 6.8% 23. Furthermore, almost all ADR increases by endoscopic imaging technology (if any) or by the use of mechanical devices were due to increases in small adenomas.…”

Section: Discussionmentioning

confidence: 99%

Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial

Karsenti¹,

Tharsis²,

Perrot

et al. 2020

Gut

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ObjectiveEndocuff Vision (ECV) is the second generation of a device designed to improve polyp detection. The aim of this study was to evaluate its impact on adenoma detection rate (ADR) in routine colonoscopy.DesignThis cluster-randomised crossover trial compared Endocuff-assisted (ECV+) with standard (ECV-) colonoscopy. Two teams of 11 endoscopists each with prior ECV experience, balanced in terms of basal ADR, gender and case volume were compared. In randomised fashion, the teams started with ECV+ or ECV- and switched group after inclusion of half of the cases. The main outcome criterion was ADR difference between ECV+ and ECV-. Subgroup analysis was done for physicians with low and high ADR (< or ≥ 25%).ResultsDuring two periods of 20 and 21 weeks, respectively, the 22 endoscopists included 2058 patients (1032 ECV- vs 1026 ECV+, both groups being comparable). Overall ADR for both groups taken together was higher with ECV (39.2%) than without (29.4%; p<0.001) irrespective of the sequence of use (ECV+ or ECV- first), but mostly in adenomas <1 cm. In the physician subgroup analysis, only high detectors showed a significant ADR increase (from 31% to 41%, p<0.001), while the increase in the low detectors was not significant (from 24% to 30%, p=0.11). ECV had a positive impact in all colonic locations, except for the rectum. No ECV- related complication was reported.ConclusionWe observed a significant ADR difference of approximately 10% by the use of ECV. By subgroup analysis, this increase was significant only in physicians classified as high detectors.Trial registration numberClinicalTrials.gov (NCT03344055).

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Section: Discussionmentioning

confidence: 99%

Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial

Karsenti¹,

Tharsis²,

Perrot

et al. 2020

Gut

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“…When the submucosal invasion is more than 500 μm in gastric cancer, and more than 1000 μm in colorectal cancer, the risk of lymph node metastasis increases and additional surgery is recommended 11 – 13 . Diagnosis of submucosal invasion based on surface structure is mainly done by magnified observation with an endoscope 14 , 15 , but it is not easy to accurately identify the deepest invasion site in a specimen and to make an H&E slide of its cross-section. In fact, cases of lymph node metastasis recurrence despite the diagnosis of R0 resection of intramucosal carcinoma after ESD has been reported.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of micro-CT-based whole tissue imaging (WTI) on endoscopic submucosal dissection (ESD) specimens

Sakamoto

Nishimura

Teplov

et al. 2022

Sci Rep

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Endoscopic submucosal dissection can remove large superficial gastrointestinal lesions in en bloc. A detailed pathological evaluation of the resected specimen is required to assess the risk of recurrence after treatment. However, the current method of sectioning specimens to a thickness of a few millimeters does not provide information between the sections that are lost during the preparation. In this study, we have produced three-dimensional images of the entire dissected lesion for nine samples by using micro-CT imaging system. Although it was difficult to diagnose histological type on micro-CT images, it successfully evaluates the extent of the lesion and its surgical margins. Micro-CT images can depict sites that cannot be observed by the conventional pathological diagnostic process, suggesting that it may be useful to use in a complementary manner.

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“…23 Although small polyps are the most frequent, in these cases lesions with advanced histological features are uncommon. 24 Despite advances in technology and the high quality of endoscopic studies, we must emphasize that failure to recognize an adenoma in small polyps and, consequently, the use of the resect and discard strategy could lead to an erroneous low-risk classification and inappropriate patient follow-up. 25 It is important to note that small polyps present a non-negligible risk of histological progression.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Patients Undergoing Colonoscopies and the Importance of Exam Quality for Colorectal Cancer Screening

Furlanetto

Zwierzikowski

Bertoldo

et al. 2022

Journal of Coloproctology

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Summary Objective To determine the impact of the quality of colonoscopy examination for colorectal cancer screening. Methods Retrospective observational study of medical records from patients treated at the endoscopy and colonoscopy service of Hospital Universitário Evangélico Mackenzie (Curitiba, PR, Brazil) from January 2019 to January 2020. Results The analysis was based on 337 medical records from patients with adenomas identified during colonoscopy, and 1,385 medical records from patients without adenomas. The estimated occurrence rate of diagnosis of adenoma during colonoscopy in the target population of the study was of 19.6%, with a 95% confidence interval ranging from 17.7 to 21.5%. Of the 337 patients with adenoma, 136 (40.4%) presented the advanced form. Statistical analysis indicated a significant association between the quality of colonoscopy preparation and test completion. Conclusion The quality of colonoscopy images is a critical factor for colorectal cancer screening, as it leads to higher rates of adenoma detection and test completion.

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Endoscopic prediction of advanced histology in diminutive and small colorectal polyps

Abstract: We identified six endoscopic predictors for advanced histology in diminutive or small colon polyps. Diminutive and small polyps lacking these predictors would not be considered to have advanced histology.

Cited by 19 publications

References 38 publications

Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial

Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial

A pilot study of micro-CT-based whole tissue imaging (WTI) on endoscopic submucosal dissection (ESD) specimens

Analysis of Patients Undergoing Colonoscopies and the Importance of Exam Quality for Colorectal Cancer Screening

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